Abstract
Neurologic damage after cardiac surgery remains an important cause of postoperative morbidity. In addition to a wide variety of procedural risks, patient-specific factors such as the presence of extracranial or intracranial atherosclerotic disease, either alone or together, have a fundamental impact on the risk of brain injury developing after cardiovascular surgery. A variety of neurophysiologic monitoring techniques have been used during cardiovascular surgery in hopes of averting neurologic injury. In this issue of Seminars, the strengths and weaknesses of each are discussed by a group of highly experienced clinical investigators. The ultrasound techniques of epiaortic scanning and continuous transcranial Doppler insonation of large intracranial arteries can alter perfusion management and surgical habits to markedly decrease the delivery of atherosclerotic, lipoidal, and gaseous microemboli to the brain and other vital organs. Cerebral hypoperfusion from unrecognized cerebral venous obstruction, inadequate mean arterial pressure, or hypocapnic cerebral alkalosis can be identified by transcranial near-infrared spectroscopy, electroencephalogram, and sensory evoked potentials. Compromise of spinal cord perfusion during the rep...Continue Reading
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May 6, 2009·Der Anaesthesist·G ErdösJ Ender
Apr 1, 2005·The Heart Surgery Forum·Scott GoldmanCandace Trace
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